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J Am Dent Assoc, Vol 138, No 3, 338-348.
© 2007 American Dental Association
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CLINICAL PRACTICE

JADA Continuing Education

Oral manifestations of Wegener’s granulomatosis

A report of three cases and a literature review



Carol Stewart, DDS, MS, Donald Cohen, DMD, MS, MBA, Indraneel Bhattacharyya, DMD, MSD, Lawrence Scheitler, DDS, MPH, Steven Riley, DMD, Kenneth Calamia, MD, Cesar Migliorati, DDS, MS, PhD, Ronald Baughman, DDS, MSD, Perry Langford, DDS and Joseph Katz, DDS

Background. Hyperplastic granular gingivitis or "strawberry gingivitis" is a rare manifestation of Wegener’s granulomatosis (WG), but it is nearly pathognomonic for this multisystem autoimmune vasculitis. The dentist may be the first health care professional to see patients with symptoms and findings of this condition. Early diagnosis and treatment is the most important factor in the management of this potentially fatal disease.

Methods. The authors present three case reports that demonstrate the disease spectrum and conducted a literature review focused on current understanding of this disease.

Results. The first patient had only the classic gingival manifestations of the disease. The second patient had simultaneous typical gingival lesions, as well as dermatologic findings. The third patient had an atypical oral presentation of aphthous ulcers and erythematous gingiva, as well as respiratory and genital involvement. Reaching a definitive diagnosis sometimes is challenging owing to the subtle onset of the disease and variable clinical and laboratory findings.

Conclusion and Clinical Implications. Clinicians should be familiar with the broad variety of oral and systemic components of WG, as well as strategies to facilitate prompt disease recognition and to provide continued oral health care to these medically complex patients.

Key Words: Wegener’s granulomatosis; hyperplastic gingivitis

Abbreviations: ACR: American College of Rheumatology. • ANCA: Antineutrophil cytoplasmic autoantibodies. • c-ANCA: Cytoplasmic antineutrophil cytoplasmic autoantibodies. • CBC: Complete blood count. • CP: Cicatricial pemphigoid. • CT: Computerized tomography. • ELISA: Enzyme-linked immunosorbent assay. • MPA: Microscopic polyangiitis. • MPO: Myeloperoxidase. • NHL: Non-Hodgkin’s lymphoma. • p-ANCA: Perinuclear antineutrophil cytoplasmic autoantibodies. • PAS: Periodic acid–Schiff. • TNF: Tumor necrosis factor. • UFCD: University of Florida College of Dentistry. • WG: Wegener’s granulomatosis. •






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